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Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008
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Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008






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    Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Presentation Transcript

    • Implications for Policy and Programming: Reflections from the RENEWAL Study, 2008 Scott Drimie, Girma Kassie & Jo Vearey University of the Witwatersrand Forced Migration Studies Programme Health and Migration Initiative
    • Urban complexity opportunities for aligned policy responses
      • Health systems
      • Urban planning
      • Environmental health
      • Social protection
      • Food systems
      • Tiers of government: local – provincial – national – regional - global
    • Studies Confirm Complex Urban Rural Linkages
    • Nutrition and Informal Settlements
      • Implications for policy and programming
      • Johannesburg as a case study
      Urban informal settlements have double the HIV prevalence of urban formal areas in South Africa
    • Dietary Diversity Score
      • A variety of foods in the diet is required to ensure an adequate intake of essential nutrients . Dietary diversity reflects the number of foods or food groups eaten over a reference period.
      • Dietary diversity can be used as an indicator of micro-nutrient adequacy (Steyn et al 2006), and as a proxy measure of the nutritional quality of the diet (Swindale and Bilinsky 2005).
      • Dietary diversity scores have been positively associated with the nutritional status of young children (Arimond and Ruel 2004) and adults (Savy et al 2007), independent of socio-economic factors.
    • Addis Ababa
    • Dietary Diversity Score:
    • Dietary Diversity Score: respondents residing informally were more likely to have a deficient dietary score Chi-square 89.880; p = <0.0001 Score 0 - 3 Score 4 - 6 Score 7 - 9 24 hour Dietary Diversity Score
    • [1 GAIn, 2009 ; Steyn et al. 2005 ; Kruger et al. 2007 Comparison of stunting (low height-for-age) for children aged 1-9 years nationally and by area of residence: South Africa 1999 and 2005 Steyn  et al (2006) showed a strong relationship between dietary diversity and child growth for South African children.
    • An Inadequate Diet: Some Issues
      • Refined foods among lowest cost sources of energy; more nutrient dense foods (lean meat, vegetables and fruit) are more costly.
      • In 2006 many healthier food items were 50% more expensive than comparable less healthy ones.
      • Low-income people will often select a diet with a high content of refined cereals, sugar and fat (Temple & Steyn, 2009).
      • Suggests economic factors may lead to selection of unhealthy diet. However, other factors such as taste and convenience are important.
    • Implications of an Inadequate Diet
      • High content of sugar and fat in cheap, less healthy foods causes them to have high energy density (ED)
      • Many investigators speculate that diets with high ED may be responsible for high prevalence of obesity in people of low socio-economic status.
      • South Africa has a high prevalence of both under-nutrition (micronutrient deficiencies in infants and children) and over-nutrition. Poor quality of available food may contribute to both conditions.
    • HIV/AIDS and nutrition are inextricably interrelated, particularly in Africa
      • Malnutrition and food insecurity are endemic in Africa, where more than 25 million people are living with HIV
      • Nearly 40% of African children < 5 are moderately or severely stunted
        • > 50% also suffer from micronutrient deficiency disorders
      • Malnutrition is not limited to children
        • > 50% of all pregnant women are anemic
    • What can be done?
      • Food access: costs of improving diets a challenge.
      • Temple and Steyn, 2009:
      • Extra cost of a healthier diet was roughly R198 per month, an amount that represents between 10% and 20% of the entire family budget (Khayelitsha, South Africa)
      • Based on food price data collected in 2006.
      • Short sighted to advise people to change diets if unaffordable.
    • What can be done?
      • Food availability: urban agriculture may contribute to urban diets
      • Major challenges in Johannesburg and Windhoek:
      • Cost of water, availability of land, weak extension/ support, weak markets, spatial planning (“Apartheid City”), poor sectoral integration
      • However, there seems to be growing interest (food prices) and there are important lessons from Addis Ababa
      • Short sighted to advise people to change diets if unaffordable
    • What can be done?
      • Food utilisation: Health promotion messages formulated to advise selection of foods that are healthy and affordable – including maize meal, oats, lentils, rice, dry beans, vegetables and fruit.
      • But what about broader structural issues? – challenge of addressing the reality of food prices. Address through:
      • Taxation? Subsidies? Disincentives for price collusion?
      • These elements of food insecurity cannot be taken in isolation
    • An Aligned Approach?
    • Implications and challenges
      • Considering the interlinked livelihood systems, what interventions are required…….
        • To improve conditions for poor urban households to create sustainable livelihoods with positive health and food security outcomes?
        • To support poor urban households to mitigate the negative impact of chronic illness?